Due to the situation with COVID-19 and the new guidelines being implemented by the Governor, we will not be accepting any ride-a-longs applications until further notice. Please check back April 1st to see if we are able to resume accepting applications again. We apologize for the inconvenience.

CITY OF ELK GROVE
Ride-Along Program Application Form

Officer Name and Signature

Officer Name*
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Identifying Information

Name*
Date*
Resident Address*
Work Address
Birthdate*

Physical Condition/ Emergency Information

In an Emergency Notify*
Address*
Do you have any physical disabilities?*
Are you under the care of a physician? *
Are you pregnant?*

Security Clearance Information

Has Applicant ever been Arrested?*
Has Applicant Ever Been Admitted to a Psychiatric Treatment Facility?*
Has Applicant Ever Been Detained for a Mental Condition Pursuant to W&I § 5150?*

Eligibility Information

Has Applicant Participated in the Ride-Along Program in the Past?*
Date Last Participated*
Eligibility*

Release of Liability, Medical Release, Indemnification and Hold Harmless Agreement for Ride-Along

The City of Elk Grove’s Ride-Along program (“Ride-Along”) is offered at the request of members of the public as a courtesy for those seeking a better understanding of the operations of the Elk Grove Police Department. A Ride-along is a potentially dangerous activity and carries with it the potential of death, serious injury, bodily harm and property damage and/or loss, including, without limitation risks caused by terrain, facilities, temperature, weather, condition of equipment, vehicular traffic and accidents, negligent non-negligent acts, and criminal action(s) of third parties, including, but not limited to, participants, volunteers, officers, and animals. 

I acknowledge the potential risks described above and, despite knowledge of such risks, I hereby assume all of the risks that may arise as a result of my participating in a Ride-Along with the Elk Grove Police Department. I certify that I am physically fit for participation in a Ride-Along, and have not been advised otherwise by a qualified medical provider. In consideration of my application and permitting me to participate in a Ride-Along, I hereby, for myself, my executors, administrators, heirs, next of kin, successors and assigns, agree and do so as follows: 

(1) Waive, release and discharge the City of Elk Grove, its officials elected and appointed, officers, employees, agents, contractors and representatives, and anyone working on their behalf (“Release Parties”), in both their public and private capacities, against any and all liability, claims, suits, losses, damages and causes of action, including all expenses of litigation and/or settlement for death, injury to, or death of any person, or for loss of, damage to, or loss of use of any property arising out of or in connection with my participation in a Ride-Along; and 

(2) Indemnify and hold harmless the Released Parties from any and all liabilities or claims made by other individuals or entities, as a result of any of my actions and/or inactions, the actions and/or inactions of the Release Parties, and the actions and/or inactions of third parties while participating in a Ride-Along. This indemnity shall apply to the fullest extent permitted by law regardless of the cause or of any fault or negligence of the City and shall apply even if the City is the sole or concurring cause of any injury, death or damage. 

I hereby consent to receive medical and hospital treatment that may be deemed advisable by the Released Parties and/or a qualified medical provider in the event of injury, accident and/or illness, fatal or otherwise, during my Ride-along. By signing this release and waiver I expressly consent to pay the costs of all emergency and/or long term care arising from my participation in the Ride-Along, including without limitation transportation expenses associated with that care. 

I am informed, understand and acknowledge that the Ride-Along in which I seek to participate is a hazardous activity. I am voluntarily participating and assuming all liability arising from the Ride-Along, with full knowledge of the risk and dangers involved. I agree that I assume and accept all risk of injury or death, and that I do this with the intention to relieve the above-named entities and persons from liability to me and all other persons whatsoever. 

I hereby expressly agree that this waiver of liability, release, indemnification and hold harmless agreement is intended to be as broad and as inclusive as is permitted by the laws of the State of California, and that if any portion, work, term, phrase, clause or paragraph of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. It is further agreed that the execution of this waiver of liability, medical release and indemnification and hold harmless agreement will not constitute a waiver by the City of the defense of governmental immunity where applicable, or any other defense recognized by the courts of the State of California and federal government. 

If executing this agreement as the parent and/or legal guardian of a minor participating in a Ride-Along, in consideration of the minor’s participation in the Ride-Along, I represent and warrant that I have the legal authority to enter into this agreement for myself and on behalf of the minor, and further agree to personally and on behalf of the minor indemnify and hold the City harmless as set forth herein to the fullest extent permissible under the law. 

* READ THIS DOCUMENT COMPLETELY BEFORE SIGNING *

Time Availability

Shift*
Day of the Week*
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Police Department Use Only

Received By*
Date*

Signature

I HAVE CAREFULLY READ THIS WAIVER OF LIABILITY, MEDICAL RELEASE, AND INDEMNIFICATION AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE CITY, AND I SIGN IT OF MY FREE WILL. I FURTHER ACKNOWLEDGE AND AGREE THAT CITY WILL INVESTIGATE MY BACKGROUND PRIOR TO PARTICIPATION IN THE PROGRAM. IF A MINOR, PARENTS/GUARDIANS MUST SIGN ALSO

Name of Applicant*
Date*
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Name of Parent/Guardian*
Date*
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Security Clearance

Background Completed By:*
Date*
Background Results*
CLETS*
ILEADS*
WebKPF*

Approval

Status*
Watch Commander Name*
Date*
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Assignment

Host Officer*
Date*
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